Chiropractic News Around the World. The Good, The Bad & The Ugly

Healthcare Fraud Sends Three to Jail

GEORGIA: An orthopedic surgeon and chiropractor from metro Atlanta are among a group sentenced to federal prison for a $3 million health-care fraud scam in late November.

Chiropractor, Dr. Arthur Hargraves, 67, of Douglasville, got three years and five months in prison. Dr. Daniel Puffenberger, 52, of Kissimmee, Fla., was sentenced to three years and months in prison.

Orthopedic surgeon, Dr. Howard Berkowitz, 58, of Atlanta got a sentence of one year and six months in prison, because he accepted responsibility prior to trial, and also assisted the government in the prosecution of the case. Berkowitz has already re-paid the entire $2.5 million restitution owed to the insurance company.

Berkowitz, Hargraves and Puffenberger operated a group of back pain clinics in North Georgia and Tennessee known as the Associated Spinal Care Network (ASCN). The three defendants were convicted of running a fraud scheme involving ASCN’s billing for a back pain procedure known as Vertebral Axial Decompression, or "VAX-D," which is a non-invasive back pain procedure that uses a mechanical table to stretch a patient’s spine. Blue Cross/Blue Shield of Georgia considered VAX-D to be investigational and not medically necessary, and made clear to health-care providers that it did not cover the procedure.

ASCN, at the direction of Berkowitz, Hargraves, and Puffenberger, nevertheless, billed Blue Cross/Blue Shield of Georgia for more than $3 million relating to the VAX-D procedure from 2001, through 2005.

Berkowitz, Hargraves, and Puffenberger were convicted of having lied to Blue Cross about what procedures ASCN was performing in order to get paid for this non-covered procedure. Instead of using the specific billing code assigned to VAX-D, ASCN used a different code that pertained to surgical nerve decompression procedures. The defendants used that code because they knew Blue Cross would pay for it, and would not pay for VAX-D.

Atlanta Business Chronicle

Chiropractor Sentenced for Overbilling

CALIFORNIA: A chiropractor from Los Gatos has been sentenced to two years in prison. 42-year-old Robert Demarco pleaded guilty in May to multiple charges of overbilling insurance companies. Demarco owns the Chiropractic Lifecenter of Los Gatos and had been accused of submitting more than $250,000 in bills to insurance companies between 2004 and 2007 for work he did not do.

Nick Muyo of the Santa Clara County District Attorney’s office says it was Demarco’s patients who tipped off prosecutors. They reported items on their statements that were not included in their treatment, which was covered by their insurance companies.

Silicon Valley News

Chiropractor’s Case Ends in Mistrial

CALIFORNIA: Jury deliberations ended with a mistrial on November 7 in the criminal case of chiropractor Wilmer Origel, who stands accused of performing illegal procedures, over billing insurance companies and money laundering. Jurors deciding the fate of Origel, 48, couldn’t reach a unanimous decision after several days of deliberating, a clerk for the San Joaquin County Superior Court said. The trial began Aug. 19.

The Modesto man faces a prison term on charges stemming from his chain of Med-1 Medical Centers in the Central Valley. He operated one out of his clinic on Wilson Way in Stockton until his 2005.

Prosecutors tried Origel on 11 felony counts. The central charge was that he performed "a controversial procedure called manipulation under anesthetics in which patients are briefly anesthetized to avoid painful adjustments."

Origel appeared in court again on Nov. 20, at which time prosecutors announced they will not retry Origel.

The Stockton Record

Former Maine Chiropractor Sentenced in Tax Case

MAINE: A former Maine chiropractor is going to prison for two years for health care fraud and tax evasion. At his sentencing in late October in federal court in Portland, 53-year-old Steven Amato was also fined $10,000 and ordered to pay restitution of $100,000 to insurance companies.

Until 2005, Amato operated the Center for Alternative Healing in Damariscotta. He now lives in California.

Amato pleaded guilty in June to one count of health care fraud and three counts of income tax evasion. Prosecutors say that during a four-year period, Amato underreported his income by a total of more than $840,000.

He also allegedly submitted false insurance claims for patient visits that never occurred or that exaggerated the time he spent with patients.

SunJournal.com

Bill Would Let Chiropractors Work on Animals

NEBRASKA: Fido could get chiropractic treatment under a bill advanced by state lawmakers.

The bill (LB463) from Sen. Cap Dierks of Ewing would let a chiropractor or other therapist treat an animal. Lawmakers say the bill came about after several chiropractors got cease-and-desist orders, telling them not to practice on animals.

Dierks says he’s seen chiropractic work on dogs with disk problems and nervous horses that are in pain.

The bill won first-round approval in early April. It also permits civil penalties against those who engage in unauthorized veterinary practice.

CALIFORNIA: The Foundation for Chiropractic Progress (www.yes2chiropractic.org), a not-for-profit organization dedicated to increasing public awareness of chiropractic, announced that Retired U.S. Army General Officer (G.O.) Becky Halstead has agreed to serve as its spokesperson and share with the public her positive experiences with chiropractic care. Halstead served 27 years with the United States Army, is the first female in U.S. history to command in combat at the strategic level by commanding the highest level organization for logistics (3rd Corps Support Command) in the Combat Theater of Iraq, and is a recipient of the 2007 national Women’s History Project Generations of Women Moving History Forward.

Halstead says that the hands-on, active care of doctors of chiropractic and their advice on a healthy lifestyle are essential to our military men and women.

Halstead explains that a chiropractor "… allows me to be part of the solution and encourages me to be part of my own wellness plan. One of the greatest emotions in the world is relief, and that is exactly what my chiropractor provides me—a tremendous amount of relief from my pain."

"It is both an honor and pleasure to welcome General Halstead as a supporter," says Kent S. Greenawalt, president of the Foundation. "Halstead exemplifies extraordinary service to this nation, and her participation as a spokesperson is a compelling message to professionals and patients, alike."

TEXAS: A woman who sought a neck adjustment then turned and sued the chiropractor for "unwanted, intrusive contact," left the Jefferson County courthouse empty handed Wednesday, April 15, as a jury found no negligence on the chiropractor’s part.

As the Record has reported, LaDonna Burge—who claimed she had an adjustment done "against her will"—filed suit in June 2007 against Dr. Scott Kerr, owner of the Community Chiropractic Center, and his colleague Dr. Ken Arola.

Before performing an adjustment, Drs. Kerr and Arola requested that Burge obtain permission from her surgeon. When the surgeon gave her the green light, Kerr and Arola consented to the adjustment and Burge submitted to two sessions in early December 2006.

A few months later, Burge, the receptionist for Community Chiropractic, filed a lawsuit against the chiropractic center, Kerr and Arola in Jefferson County, claiming the adjustments were performed "against her will" and had worsened her already traumatized neck.

During opening statements, plaintiff’s attorney Mike Pierce said Arola failed to exercise good judgment by consenting to Burge’s requested adjustment and is, therefore, negligent.

The plaintiff argued that a prudent chiropractor would know that an adjustment on someone who had recently undergone spinal surgery should not be done until the fused vertebrae were solid—which can take up to one year. However, court documents show Community Chiropractic Center professionals did X-ray Burge and determined that the fused vertebrae were solid before performing the adjustment.

But jurors found no evidence that Dr. Arola was negligent, and awarded Burge nothing.

CONNECTICUT: Eugene Bolognese, a Simsbury chiropractor, pleaded guilty Jan. 22 to a single count of health care fraud, the U.S. attorney’s office said.

From August 2005 to December 2007, Bolognese employed two physicians in his practice and used their provider numbers to file claims for services on days they did not work. The fraudulent claims, Bolognese admitted, amounted to $573,036.

The government asked for a prison sentence of 30 to 37 months to penalize Bolognese for his conduct and to set an example. Bolognese’s attorneys argued for no prison. They said his conduct was a result of his poor business management skills and his reliance on someone else to do his billing. They also claimed a prison sentence would harm his young children and his patients, and diminish his ability to make restitution.

Prosecutors objected to U.S. District Judge Janet Bond Arterton’s sentence of six weeks. Bolognese will also be on probation for three years after his release.

Bolognese, in addition to agreeing to make restitution to Blue Cross and Blue Shield, has agreed to sell the building that housed another of his businesses and to turn that money over to the government go toward restitution.

Bolognese, 37, has also placed his home on the market to cover the restitution. He’s asking $1.049 million.